Medizinische Klinik V, University Hospital Heidelberg, Heidelberg, Germany.
Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Am J Hematol. 2016 Nov;91(11):E473-E477. doi: 10.1002/ajh.24533. Epub 2016 Sep 3.
Deletion 17p13, del(17p), is associated with poor outcome in myeloma but some patients show long-term survival. With the current study we intended to identify factors impacting outcome of such high risk patients. We analyzed 110 newly diagnosed, symptomatic patients with del(17p) detected by fluorescence in situ hybridization (FISH) in CD138-purified myeloma cells to identify prognostic factors for survival. Age >65 years, ISS III, and elevated LDH negatively impacted survival. Patients with subclonal (10-60% of plasma cells) del(17p) had longer progression-free survival (PFS) than patients with del(17p) in >60% of plasma cells (26 vs. 19 months, P = 0.03). Additional gain of 1q21 was associated with shorter PFS (17 vs. 25 months, P = 0.01). Hyperdiploidy did not ameliorate impact of del(17p), but gain 19q13 predicted longer PFS (30 vs. 18 months, P = 0.01) and overall survival (50 vs. 29 months, P = 0.01). Multivariate analysis in transplant eligible patients (≤65 years) revealed better survival for patients treated with upfront autologous transplantation (hazard ratio, [95% confidence interval]: 0.15 [0.04, 0.58], P = 0.006). Application of maintenance therapy was associated with better survival in transplant-eligible patients (0.30 [0.09, 0.99], P = 0.05). We demonstrate heterogeneous outcome of patients with del(17p) according to baseline characteristics and treatment. 19q13 should be included in routine FISH panel, since gains were associated with better survival. Am. J. Hematol. 91:E473-E477, 2016. © 2016 Wiley Periodicals, Inc.
17p13 缺失，del(17p)，与多发性骨髓瘤的不良预后相关，但部分患者有长期生存。本研究旨在确定影响此类高危患者预后的因素。我们分析了 110 例新诊断的、有症状的、用荧光原位杂交（FISH）在 CD138 纯化骨髓瘤细胞中检测到 del(17p)的患者，以确定生存的预后因素。年龄 >65 岁、ISS III 期和升高的 LDH 对生存有负面影响。亚克隆（10-60%的浆细胞）del(17p)的患者比浆细胞中 del(17p)>60%的患者有更长的无进展生存期（PFS）（26 对 19 个月，P=0.03）。1q21 的额外增益与较短的 PFS 相关（17 对 25 个月，P=0.01）。超二倍体不能改善 del(17p)的影响，但 19q13 的获得预测更长的 PFS（30 对 18 个月，P=0.01）和总生存期（50 对 29 个月，P=0.01）。在可移植患者（≤65 岁）的多变量分析中，发现 upfront 自体移植治疗的患者有更好的生存（风险比，[95%置信区间]：0.15 [0.04, 0.58]，P=0.006）。可移植患者中应用维持治疗与更好的生存相关（0.30 [0.09, 0.99]，P=0.05）。我们根据基线特征和治疗方法，展示了 del(17p)患者的异质性结局。由于增益与更好的生存相关，19q13 应包含在常规 FISH 面板中。Am. J. Hematol. 91:E473-E477, 2016. © 2016 Wiley Periodicals, Inc.
